Provider Demographics
NPI:1043373814
Name:ODONTOLOGIA GENERAL Y PEDIATRICA
Entity type:Organization
Organization Name:ODONTOLOGIA GENERAL Y PEDIATRICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:LIONEL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-250-5055
Mailing Address - Street 1:CLINICA LAS AMERICA
Mailing Address - Street 2:400 AVE ROOSEVELT SUITE 505
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-250-5055
Mailing Address - Fax:787-250-0511
Practice Address - Street 1:CLINICA LAS AMERICA
Practice Address - Street 2:400 AVE ROOSEVELT SUITE 505
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-250-5055
Practice Address - Fax:787-250-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherTRIPLE-S
PR=========OtherMCS